People in Public Health A study of approaches to develop and support lay people in public health roles

Volunteering in the UK 71% of adults volunteer in some way. 53% volunteer in the sport/exercise sector; 25% in health, disability and social welfare 24% with local community or neighbourhood groups. (2008/9 DCLG Citizenship Survey)

Examples of public health programmes involving lay workers Pathways to Action – training for community health activists ‘Healthwise’ tutors running groups around physical activity and health topics Health apprenticeship schemes Health trainers Breastfeeding peer support Asian outreach workers Buddy schemes around HIV/AIDS Voluntary walk leaders Community coaches Lay workers running food co-ops & cook and eat sessions Healthy Living Centres Sure Starts/Children’s Centres

Study Aims To improve understanding of valid approaches to identifying, developing and supporting lay people who take on public health roles in community public health activities. To undertake research on public perspectives regarding the acceptability and value of lay people in public health roles To aid public health commissioning and planning by identifying elements of good practice and how these might be applied to different contexts.

Scientific Knowledge Literature Review Practice based knowledge Expert Hearings Site visits Primary Research Case Studies Study design

Case studies Walking for health (local scheme) Breastfeeding peer support Neighbourhood health project Sexual health outreach Community Health Educators Interviews with 90 participants: – Public health workforce – Lay people in public health roles – Other partners Interviews and focus groups with 46 service users in 3 of the case studies: – Walking for Health (20) – Breastfeeding peer support (11) – Neighbourhood health project (15)

Conclusions – The rationale for lay involvement 1.To increase capacity - a ‘community workforce’ increases programme reach 2.To reach some communities that professionals cannot Lay workers offer a distinctive type of support that can break down communication and other barriers. 3.To provide a conduit between organisations and communities community knowledge can be fed into organisation information can be cascaded through social networks 4.To provide an essential bridging role reducing barriers between services and community and improving access. – particularly where groups are seldom heard or not in touch with traditional services. 5.To mobilise community resources to improve health. 6.For people who get involved - commitment to a community and desire to give back can result in a positive experience and lead to longer term health/social benefits.

What are the challenges? Organisational culture in the NHS & public sector Gaps in support for lay people Barriers to involving lay people from communities that are seldom heard

Recommendations Work to remove barriers to recruitment Be clear about what is expected of volunteer role Manage risk through providing training and development opportunities Consider the pros and cons of providing some financial support and make best decision for you Provide light touch support to show that people are feel valued and ensure the service is effective Invest in development and support within delivery organisations and in a wider infrastructure

What sort of payment, if any, do you think volunteers working in public health should receive?

Case studies – payment? Sexual health outreach – Volunteer only Walking for health (local scheme) – Volunteer only BUT previous sessional payment to cover expenses Breastfeeding peer support – Paid peer support workers – Volunteer scheme in addition Community Health Educators – Sessional payment Neighbourhood health project – Volunteer only Some schemes offer incentives eg gym membership

Walking for Health – practitioner view on withdrawal of sessional payment “The volunteers produce a timetable, keep their website up to date, make sure they’re insured, make sure they’re recce-ing the route, they make sure they’re trained, they're taking all their health questionnaires, and keeping it all locked away. To say ‘Oh, we're not going to pay you but now you have to do this as well…”

Payment Advantages Helps with employability Supports people on low incomes Helps with retention Indicates value Can expect more? Disadvantages Potential to undermine volunteer ethos Could create a hierarchy between (low or sessionally paid) volunteers and paid (employed) workers Project costs more

The big questions Are we in danger of substituting volunteers for paid employees? Are we trying to develop a community workforce or support community activists? Are the two aims compatible? What is fair when we are working with disadvantaged communities in the context of an economic recession? Are communities best left to organise their own support networks, free of professional interference?

Find out more The final report of the study is now available to download from PIPH website A briefing for practitioners has now been produced Visit the PIPH website and register your interest in the study